Thyroid Eye Disease Service, Department of Ophthalmology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Korean J Ophthalmol. 2023 Apr;37(2):147-156. doi: 10.3341/kjo.2022.0131. Epub 2023 Apr 5.
Thyroid receptor antibodies can quantify thyroid eye disease activity, predict outcomes and aid timing of interventions. The type and generation of assay is frequently unspecified, complicating meta-analyses. To determine the clinical and biochemical relationships between a second-generation thyrotropin receptor-binding inhibition antibody (TRAb) immunoassay, detecting stimulatory and blocking antibodies, with the thyroid stimulating immunoglobulin (TSI) bridging immunoassay detecting the stimulatory component only.
Retrospective review of 100 consecutive patients attending a regional specialist service. For each patient and visit, both a TRAb and TSI were performed, and a clinical activity score (CAS) recorded.
A significant positive correlation between TRAb and TSI (rho = 0.828, p < 0.01) but a weaker correlation between the assays and CAS (TRAb: rho = 0.439, p < 0.01; TSI: r = 0.357, p < 0.01) were found. In 10% of the episodic data, patients had a TRAb level that was disproportionately high (39.41 ± 52.84 IU/L), compared to their TSI levels (9.53 ± 12.10 IU/L) with a higher-than-average CAS (2.47 ± 1.78; range, 0-5). Within 12 months of diagnosis, a significant positive correlation between CAS and TRAb (rho = 0.503, p < 0.01) as well as between CAS and TSI (rho = 0.329, p < 0.01) were found. In patients with a diagnosis over 12 months, the correlation with CAS for both TSI and TRAb were Spearman rank correlation coefficient of 0.347 (p < 0.01) and 0.327 (p < 0.01), respectively.
TRAb and TSI correlate strongly and to a lesser extent with the CAS. For most patients, TRAb can be replaced with the more economical TSI. TRAb also correlates better with newly diagnosed, more active patients than TSI. In a subset of patients, blocking antibodies may play a significant pathogenic role, requiring different treatment and monitoring. Further studies are required to investigate this relationship.
甲状腺受体抗体可量化甲状腺眼病的活动度，预测结果并辅助干预时机的选择。检测刺激和阻断抗体的第二代促甲状腺素受体结合抑制抗体（TRAb）免疫分析的类型和代际通常未予具体说明，这使得荟萃分析变得复杂。本研究旨在确定第二代促甲状腺素受体结合抑制抗体（TRAb）免疫分析（检测刺激和阻断抗体）与仅检测刺激成分的甲状腺刺激免疫球蛋白（TSI）桥联免疫分析之间的临床和生化关系。
对 100 例连续就诊于区域专科服务的患者进行回顾性分析。对每位患者和每次就诊，均同时进行 TRAb 和 TSI 检测，并记录临床活动评分（CAS）。
TRAb 和 TSI 之间存在显著的正相关（rho=0.828，p<0.01），但与 CAS 的相关性较弱（TRAb：rho=0.439，p<0.01；TSI：r=0.357，p<0.01）。在 10%的发作性数据中，与平均 CAS（2.47±1.78；范围，0-5）相比，患者的 TRAb 水平（39.41±52.84IU/L）显著偏高，而 TSI 水平（9.53±12.10IU/L）较低。在诊断后 12 个月内，CAS 与 TRAb（rho=0.503，p<0.01）以及 CAS 与 TSI（rho=0.329，p<0.01）之间存在显著的正相关。在诊断超过 12 个月的患者中，TSI 和 TRAb 与 CAS 的相关性均为 Spearman 秩相关系数 0.347（p<0.01）和 0.327（p<0.01）。
TRAb 和 TSI 高度相关，与 CAS 的相关性稍差。对于大多数患者，TRAb 可被更经济的 TSI 取代。与 TSI 相比，TRAb 与新诊断的、更活跃的患者相关性更好。在一部分患者中，阻断抗体可能发挥重要的致病性作用，需要进行不同的治疗和监测。需要进一步的研究来调查这种关系。
